The aims of this project are evaluate a state-level program to promote quality nursing home care in a cost-effective manner and to disseminate lessons learned from this program. Minnesota Performance-Based Incentive Payment Program (PIPP) moves beyond conventional pay for performance programs to not only offer financial incentives but also to equip providers with the tools to increase their performance. It uses a competitive application process to fund innovative, provider-initiated projects which meet the program goal of improving nursing home quality in a manner which reduces unnecessary costs. The evaluation will identify factors that lead to successful implementation and sustainability of quality improvement, identify tangible or intangible benefits to providers and the state, and disseminate effective quality improvement projects across the nursing home industry. The evaluation will be achieved through the following methods: A comprehensive survey of providers, including providers who participated in a funded PIPP project, providers who applied for PIPP but were not funded, and providers who did not apply. In-depth organizational analysis and business case study of 20 funded PIPP projects to determine what factors contributed to successful project implementation and return on investment. Quantitative analysis of nursing home quality data to draw comparisons between PIPP and non-PIPP facilities in their trends of nursing home quality. Analysis of PIPP program benefits, costs, and fiscal impact from both a state and consumer's perspective. The project will result in a PIPP toolkit and other quality improvement resources for nursing homes and funding agencies both locally and nationally. PUBLIC HEALTH RELEVANCE: This research will advance public health by identifying organizational structure, process, and cultural factors that lead to successful implementation and sustainability of nursing home quality improvement projects, assessing the case for state investment in quality improvement, and determining the savings to Medicaid and funding sources potentially achieved by improving upon the value of healthcare. Additionally, national dissemination of methods to enhance nursing home quality and value is of importance to nursing home consumers, the long term care industry, and governmental funding agencies.